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Ophthalmology Management

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Early Real-World Outcomes with Second-Generation Trabecular Micro-Bypass Stents Implanted in Combination with Cataract Surgery

Ophthalmology Management March 1, 2020

As a comprehensive ophthalmologist who mainly provides refractive and cataract surgery, most of the patients I see who have glaucoma fall in the mild or moderate category and may or may not have been previously diagnosed.

The iStent inject® is an opportunity to provide them with needed treatment for glaucoma, possibly without the cost, inconvenience, and ocular surface effects of eye drops. And, importantly, U.S. clinical trial data3 show that combining iStent inject with cataract surgery doesn’t raise patients’ risk vs. cataract surgery alone.

The data I’ve analyzed in my practice, from 142 combined cataract/iStent inject procedures primarily in patients with mild glaucoma, are similarly positive with regard to efficacy and safety (see Table 1).

TABLE 1
RESULTS - WANDLING
(n=74 of 142 with 3-6 month follow-up)
Pre-Op Post-Op
Mean IOP 17.9±4.4 mmHg 13.5±2.9 mmHg @ 3 mo (p<0.001)

11.5±1.9 mmHg @ 6 mo (p<0.001)
Reduction in mean IOP 24-35%
Mean # of medications 0.6±0.9 0.25 +/- 0.55
Eyes with IOP ≤ 15 mmHg 30% 76-100%

Among patients who are 3 months and 6 months post-surgery, mean IOP is 24% to 35% lower compared with preoperatively. In addition, by 5 to 7 days post-op, eyes that undergo the combined procedure are indistinguishable from eyes that had cataract surgery alone.

Future analyses from my practice will include a larger cohort of eyes as well as data on medication use.

Investigator Insight: iStent inject is a promising addition to the MIGS armamentarium for the comprehensive ophthalmologist.

I don’t perform trabeculectomy or tube shunt surgeries, but iStent inject enables me to provide the best possible care for my patients who have mild-to-moderate glaucoma, perhaps decreasing the likelihood they’ll need a more invasive procedure in the future.

REFERENCES

  1. Craven ER, et al.; iStent Study Group. J Cataract Refract Surg. 2012;38(8):1339-1345;
  2. Neuhann TH, et al. J Cataract Refract Surg. 2019;45(3):312-320;
  3. Samuelson TW, et al. Ophthalmology. 2019;126:811-821;
  4. Huang AS, et al. Ophthalmology Glaucoma. 2019;2(1):11-21;
  5. Huang AS, et al. Invest Ophthalmol Vis Sci. 2016;57(11):4558-4565;
  6. Clement CI, et al. Clin Ophthalmol. 2019;13:491-499;
  7. Hengerer FH. Presented at the 2018 annual meeting of the American Society of Cataract and Refractive Surgery. Washington, D.C.;
  8. Arriola-Villalobos P, et al. J Ophthalmology. 2016;2016:1056573;
  9. Gazzard G, et al. Lancet. 2019;393(10180):1505-1516.
GEORGE R. WANDLING JR., MD, is a refractive cataract surgeon and comprehensive ophthalmologist at North Suburban Eye Specialists in Minnesota.

GEORGE R. WANDLING JR., MD, is a refractive cataract surgeon and comprehensive ophthalmologist at North Suburban Eye Specialists in Minnesota.

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